Never ending headache...nerve pain...root canal?

Hi, I have posted in the Headache Forum, but wanted to get some insight.  I appreciet anyone's input.

I have had a headache now for about 12 days straight, no relief, the pain is completely unresponsive to anything I have taken (from Vicodin to Imitrex, to Motrin.).  I have also been on an antibiotic for almost a week now.

I have NO prior history of headaches and have had mostly a complete medical work-up, all results normal.

This is my fear...I had a root canal done on one of my top left teeth (about 3rd one back from front tooth) approx a month ago.  Within a few days of the successful RC, I began having nerve-like pains in that tooth.  I'm talking SEVERE jolts...a few times, the pain was so bad it almost brought me to me knees.  I have had nerve pain before and have no doubt that is what it was.  It would happen when I would bend down suddenly, or breathe in thru my mouth.  The nerve pain persisted, I told my DMD...he XRayed the root canal'ed tooth and assured me it was healing well.

As weeks went by, the nerve pain subsided a bit, became a little less frequent, and not as "shocking" as it was initially.  Last week, that tooth "ached" for hours on end (no nerve pain)....I finally got it to calm down, and ever since then, I have had the headache.  I also was getting intermittent h/a's prior to this one, but they always went away with Excedrin.  NO "nerve" pain in that tooth since the h/a started.

The h/a is definitely worse on the left, is centered around the temple area, and a wee bit into the forehead.  My left eye was twitching for days on end, until I started the antibiotic.  I am now having tingling sensations in the back (left) side of my head and "goosebumps" on my left arm a few times a day...and my eyes feel goofy.  Also, I have a constant very dull ringing in my ears, worse on the left.


I have tried to consider all possibilities, and my dentist has said worst case scenario, we extract the tooth if we feel it is the culprit.  I was trying not to be rash, but it is the ONLY thing that makes sense???  Is it possible that perhaps there is a pinched nerve?  Is this a common thing following a root canal?  If that IS what it is, I am now worried I will have some sort of permanent damage, even if I get the tooth out???  I know the tooth nerve itself is gone, but my dentist told me that there are a ton of nerves in the socket, etc.

The other thing I wanted to mention, is he showed me on my x-rays that the very very tip of the root of that tooth is "s' shaped.  He said that is rare...but he also said the "fill" in the canal was successful, and went all the way to the tip.  I'm not worried about any sort of infection, as the xrays have all been good.

He advised me to go to an oral surgeon to get the back molar on that same row extracted, JUST to eliminate that as a possibility (it needed to come out)...that was done successfully on Friday...I tolerated that very well.

HELP!!!!!

I hate to just yank the tooth....(my friday extraction was my first ever pulled tooth) but NOTHING else in the world makes sense....and nothing has even touched the pain.  I'm beside myself at this point.

I'm praying someone posts and tells me that this is actually a phenomenon that isn't an impossibility.

Thank you in advance for spending the time to post to me.

[scottma]

The presenttion of your orofacial pain does appear to be related to temporomandibular disorder. However, the symptoms appeared to be triggered by root canal treatment, which is extremely rare. Most tmd patients have insidious onset of symptoms, and the pain is not triggered by any event.
Firstly, I do'nt think extracon of the root canaled tooth is going to solve the problem.
Secondly, your neurologic symptoms appear to be consistent with the documentation in the book,Travell and Simon's myofascial painand dysfunction the trigger point manual,volume1. quote: Trigger area 7 may be associated with spontaneous episodes  of  a " queer shivery feeling" with pilomotor erection(gooseflesh) on the anterolateral surfaces of the homolateral arm, and sometimes of the  thigh(Fig6.4). The feeling produced by this referred autonomic response is described as " like shivers running up and down the spine" when chalk or a fingernail scrapes across a blackboard." Page287.
Thirdly, youmay need to see ent and neurologist to rule out structural pathology.
Forthly, Seeing a tmj specialist , chiropractor, or physician familliar with myofascial trigger point therapy.

[nursegirl6572]

Thank you so much for the information.  I also think the rapid onset is strange, and that, coupled with the nerve pain I had for a while in that tooth, made me think that somehow the root canal'ed tooth is the culprit.

I spoke with my dentist yesterday who told me that there could be a crack in the tooth up in the root that we wouldn't see on an XRay.  He said he has seen this kind of thing before, while of course, not very common.

LOL....I've never wished so hard for a dental issue in my life.  I'm a huge dental sissy and waited MONTHS to have that tooth repaired.  At this point, I'd almost prefer the tooth ache pain over this, it is soooo frustrating and debilitating.

Thanks again for your insight.

[nursegirl6572]

Hi scott,

Just an update.  I'm still having the headaches, the neuro symptoms have settled a bit.  I am on my last day of antibiotics and the last day of a course of steroids (Medrol dose pack).  It's funny...during this whole headache, that tooth itself never ached, except for the day after the antibiotics and steroids were started.  Very dull ache (especially compared to the headache).  I find that interesting, though.

I went to see my PCP yesterday and spelled everything out.  My exam was PERFECTLY normal....ears are fine, nose, everything.  Neuro exam was completely normal.  My PCP recommends an extraction.  She also said the rapid onset is fishy, along with the nerve-like pain I had post RC.

I'm just praying this is the solution.  I've held off for a while, just hoping something else would make sense...or that I would be able to see some improvement.  My DMD said he HAS seen this kind of thing before, though rare.  He also said even though the XRay shows a healing RC, that there could be issues (like a crack) way inside the tooth that would never be visible on a film.

Any input you have would be great.  I can't think of any other solution.  If something is sitting on a nerve, I can't think of anything else that would fix the issue except to remove the irritation?

Thanks again!